Search This Blog

Thursday, July 21, 2011

California Loopholes

To anyone who follows autism politics, it should come as no surprise that the California managed care agreement is less than it appeared at first. At The San Francisco Chronicle, Laura Shumaker quotes Feda Almaliti, founder and executive director of Autism Health Advocates.
Once upon a time, in a room very nearby, a group sat down at a table behind heavy doors. Some in the group were regulators appointed by a governor named Brown, and some were representatives of a major health plan. But no one at that table was a parent whose child needed therapy, no one there would raise real-life issues or concerns. No one would ever say "Nay."

This fairy tale gathering happened last Monday, July 11th. The regulatory agency was the California Department of Managed Health Care (DMHC) and the health plan was Blue Shield of California.

Together they created a fairy tale settlement agreement because many families in the Land of California have been trying to get insurance coverage for their children with autism. These parents didn't want fairy dust or dolphin therapy. They want their insurance provider to cover the most effective and well-studied studied therapy available for their children, Applied Behavior Analysis (ABA therapy).

Now everyone in the Land of California can read this "settlement agreement." (Here's a link.) It says that Blue Shield will provide ABA to children with autism spectrum disorders. But like in all fairy tale contracts, this one comes with a catch.

They have imposed requirements that can't possibly be met. They have defined the education and certification level of qualified providers at an impossible standard, beyond what is customary in this state. The mythical providers of the therapy they have approved are as rare as unicorns.


Postscript: Just before this article went live, the DMHC signed another settlement agreement, this time with Anthem Blue Cross of California. It hasn't been released yet.

But we already know what it says.


Senator Steinberg has asked the Director of the Department of Managed Health Care to defer settlement agreements until loopholes are addressed.